David Levy, MD, FRCP Foot ulceration The ulcerated, infected and possibly gangrenous foot is a common reason for hospital admission. Anatomically, diabetic foot ulceration is restricted to the region distal to the ankle; proximal lesions are more likely ischemic, vasculitic, venous, or to have another underlying cause. Most ulcers are predominantly …

David Levy, MD, FRCP Introduction The devastating consequences of diabetic neuropathy are seen every day both in hospital – more bed days are taken up with the consequences of diabetic foot ulceration than any other diabetic complication – and in primary care, where sensory symptoms, especially pain, and autonomic neuropathy, especially …

David Levy, MD, FRCP Cataract Diabetes is a strong risk factor for cataract, and it occurs earlier and progresses faster than in the non-diabetic population. Cortical cataract is the most frequent, with its typical radial spoke opacities. Indications for cataract surgery include impairment of vision that reduces quality of life, and …

David Levy, MD, FRCP Pre-proliferative retinopathy An important diagnosis, as there is a very high risk of progression to proliferative retinopathy and significant visual loss. Pre-proliferative changes are characterized by the following. Multiple (> 5) cotton-wool spots. Multiple large blot hemorrhages. Venous abnormalities: irregularities, beading, looping or reduplication. Intraretinal microvascular abnormalities: …

David Levy, MD, FRCP Non-proliferative diabetic retinopathy Background retinopathy Microaneurysms Small, red, intraretinal lesions usually found at the posterior pole of the eye, around the disc and macula. They occur in areas of capillary non-perfusion and show leakage of fluorescein. It is worthwhile estimating the number of microaneurysms as it has …

David Levy, MD, FRCP Introduction Diabetic retinopathy is the most common clinically significant microvascular complication of diabetes, but cataract is the most common ocular complication, with a prevalence of about 60% in those aged 30–54, five times more frequent than in those without diabetes. Diabetes is also associated with raised intraocular …

David Levy, MD, FRCP Other management problems in diabetic nephropathy Glycemic control Once nephropathy is established, good control of blood pressure and lipids is probably more important than glycemic control. Observational studies abound and show that, for example, patients with advanced renal failure entering renal replacement programmes survive longer with a …

David Levy, MD, FRCP Management of diabetic nephropathy Investigations Mid-stream urine if leucocytes on routine urinalysis. Renal tract ultrasound scan: a. Normal renal length is about 11 cm, correlating weakly with height and BMI; it is about 10 cm in South Asian and oriental subjects. Kidneys are large in the poorly …